Healthcare Provider Details

I. General information

NPI: 1417758616
Provider Name (Legal Business Name): NORTHERN HILLS NUTRITION AND DIETETICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 GOOSEBERRY RD
SPEARFISH SD
57783-9008
US

IV. Provider business mailing address

428 GOOSEBERRY RD
SPEARFISH SD
57783-9008
US

V. Phone/Fax

Practice location:
  • Phone: 605-215-1838
  • Fax:
Mailing address:
  • Phone: 480-285-5662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: SHAWNA SMOOT
Title or Position: REGISTERED DIETITIAN/OWNER
Credential: RDN LN
Phone: 480-285-5662